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Attention and Hypnosis:
Neural Substrates and Genetic
Associations of Two Converging
Processes
AMIR RAZ
a
a
Columbia University and New York State Psychiatric
Institute, New York, USA
Published online: 20 Aug 2006.
To cite this article: AMIR RAZ (2005) Attention and Hypnosis: Neural Substrates and
Genetic Associations of Two Converging Processes , International Journal of Clinical and
Experimental Hypnosis, 53:3, 237-258, DOI: 10.1080/00207140590961295
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Journal of Clinical and Experimental Hypnosis, 53(3): 237–258, 2005
Copyright © Taylor & Francis Inc.
ISSN: 0020-7144 print
DOI: 10.1080/00207140590961295
ATTENTION AND HYPNOSIS:
Neural Substrates and Genetic Associations
of Two Converging Processes
0020-7144
NHYP
Journal
of Clinical and Experimental Hypnosis,
Hypnosis Vol. 53, No. 03, April 2005: pp. 0–0
Attention
AMIR
RAZ
And Hypnosis
AMIR RAZ1,2
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Columbia University and New York State Psychiatric Institute, New York, USA
Abstract: Although attention is a central theme in psychological
science, hypnosis researchers rarely incorporate attentional findings
into their work. As with other biological systems, attention has a
distinct anatomy that carries out basic psychological functions.
Specific brain injuries, states, and drugs can all influence attentional
networks. Investigation into these networks using modern neuroimaging techniques has revealed important mechanisms involved in
attention. In this age of genomics, genetic approaches can supplement
these neuroimaging techniques. As genotyping becomes an affordable and technologically viable complement to phenotyping, exploratory genetic assays offer insights into the genetic bases of both
attention and hypnotizability. This paper discusses relevant aspects
of attentional mechanisms and their underlying neuroanatomy as
they relate to hypnosis. Underlining data from attentional networks,
neuroimaging, and genetics, these findings should help to explain
individual differences in hypnotizability and the neural systems subserving hypnosis.
The notion of attention is an integral, defining aspect of hypnosis. Despite the important role attention plays in the hypnotic process, hypnosis practitioners and researchers tend to overlook
attentional processes. However, psychological and neurobiological
investigations have revealed important empirical information about
the anatomy and mechanisms of attentional processing. In this
paper, we will reexamine these existing data in the context of our
novel findings to reveal even closer connections between attention
and hypnosis.
One of the oldest and most central issues in psychological science,
attention is the process of selecting for active processing certain aspects
Manuscript submitted March 22, 2004; final revision received December 17, 2004.
1
Selected themes and portions of this paper appear in German in the Jubilee edition
of HyKog (Raz, Fossella, McGuiness, Zephrani, & Posner, in press) and in a book chapter
(Raz, Fan, & Posner, in press).
2
Address correspondence to Amir Raz, Ph.D., Columbia University College of
Physicians & Surgeons and New York State Psychiatric Institute, 1051 Riverside Drive,
Box 74, New York, NY, 10032, USA. E-mail: ar2241@columbia.edu
237
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AMIR RAZ
of our physical environment (e.g., objects) or ideas stored in our memories. Throughout history, many great minds have wrestled with the
definition of attention. Aristotle regarded attention as a narrowing and
focusing of the senses. Years later, William James (1890, p. ) wrote,
“Everyone knows what attention is. It is the taking possession of the
mind in clear and vivid form of one out of what seem several simultaneous objects or trains of thought.” James’s mention of attention
toward either objects or thoughts relates to today’s approaches to “sensory
orienting” and “executive control.”
Following a lull in the field during the early 1900s, after World War II
Donald Broadbent resumed the quest to discover attentional mechanisms. Applying formal information theory, Broadbent likened attention to a filter. He proposed that attention was bounded by the amount
of information located between parallel sensory systems and a limited
capacity perceptual system (1958). This view facilitated objective
studies of the limitations of the human ability to deal with multiple
signals at one time in a variety of practical tasks.
As psychology moved toward the study of cognitive mechanisms,
new objective methods allowed for investigation into attentional selection. For example, studies showed that words could activate their
semantic associates without awareness to the word’s identity (i.e.,
priming). The parallel organization of sensory information was also
extended to semantic processing. In this case, selecting a word meaning
for active attention actually suppresses the availability of alternative
word meanings. These data revised the notion of attention as a filter,
instead describing it as a mechanism for assigning priority to motor
acts, consciousness, and memory.
Psychological studies have furnished interesting results about the
limits of performance and unconscious processing. Supplementing
these findings with neurological data has provided a more complete
picture of the neural mechanisms of attention. Cognitive neuroscientists
have suggested that the human brain concurrently entertains several
attentional systems, or networks, consisting of separate interrelated
functions (Posner & Petersen, 1990). Brain networks that subserve
attention are now well described and serve as model systems for
exploring symptoms that arise from various forms of pathology
(Berger & Posner, 2000). Recent data break down the whole process of
attention into distinct brain areas that mediate different processes. We
can thus construct attention as an organ system with its own functional
anatomy, circuitry, and cellular structure (Posner & Fan, 2004).
This information about attentional processing raises important
questions in cognitive science (e.g., what is the relationship between
attention and consciousness?) and provides insights into neurological
and psychiatric disorders. Furthermore, the data establish that attention
permits voluntary control over thoughts, feelings, and actions as a
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means of self-regulation in adulthood and across development (Bronson,
2000; Posner & Rothbar, 1998, 2000; Rothbart, Ellis, & Posner, in press).
Variations in the operational efficiency of these attentional systems
serve as a basis for individual differences in self-regulation and
emotional control. Careful study of these individual differences should
help illuminate mechanisms of volition and sustained effort as well as
the influence of suggestion on brain function (Raz, in press-b). These
aspects of attention are compatible with recent data regarding hypnotic
phenomena (Raz & Shapiro, 2002).
GROSS CHARACTERISTICS OF ATTENTION
To study the neurological characteristics of attention, an experimental
system must be employed. Visual attention often serves in this capacity,
because it is the most widely studied perceptual system. Researchers
and clinicians have investigated the optics, anatomy, development,
pathology, and underlying neural processes of the visual system. More
recently, Raz et al. documented the effects of attention on visual acuity
in hypnotic contexts (Raz et al., in press).
In practice, visual attention allows us to explore how we redirect
our attentional “beam” to various areas of the visual field and change
the detail with which we look at a particular area. For example, a
reader can look at this page and focus on its setup as a whole, or he or
she can zoom in on specific words and certain letters therein. Paying
attention to single characters permits us to examine punctuation
marks, catch typos, or even spot minute imperfections on the physical
paper. However, at this level of detail, we may miss the bigger idea
conveyed in a paragraph. As we shift our focus, we can change the
target location of our attention or the size of our attentional field. Metaphors that describe visual attention, such as spotlight, zoom lens, gating,
and gradient, attest to the fundamentally spatial nature of attention.
The term spotlight exemplifies our common knowledge of the different
types of attention needed for reading versus proofreading.
When presented with a large visual array of targets for our attention,
we can choose to examine our environment globally, or we can focus
on specific features. Damage to components of the neuronal network
impairs this ability to shift between attentional targets. Patients with
difficulty examining local features usually have a damaged left
temporo-parietal lobe. Other patients may do well with local features but
fail to absorb the overall contour; they usually have a damaged right
temporo-parietal lobe. Indeed, the parietal lobe tends to emphasize the
shifting between local and global attention, whereas the temporal lobe
determines whether one can actually examine a local or global feature
of a stimulus.
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In the process of visual attention, we usually foveate, or look at, our
exact item of interest. Although our attention generally relates to
where we fixate, it is easy to dissociate the two processes. If we cue
someone to focus their attention on a location in space other than the
center of gaze, they become sensitive to information occurring at the
cued location and insensitive to information at the fovea. The attentional focus rather than the visual focus maintains a low threshold and
fast response time. We use these covert attentional shifts to determine
where in the visual field we will target our gaze.
Attention to visual elements can also apply to other modalities, such
as the auditory system. When multiple people talk simultaneously, we
may select one stream of conversation to follow in detail. To direct our
attention, we often visually orient toward the person speaking and
hone in on the frequency of their voice or the content of the information
relayed. When we attend to one stream, the other auditory stimuli fade
into the background. The information is present but does not reach
focal analysis. Data indicate that we process much of this unattended
information in subtle and complicated ways. We can suddenly gain
interest in unattended information (e.g., because our name is mentioned) whereby we quickly shift attention to the new information.
Researchers have studied these attentional phenomena experimentally
in some detail.
COMPONENTS OF ATTENTION
There is an emerging consensus that attention does not constitute a
singular mechanism but is instead a complex system presiding over a
number of distinct neuronal circuits. Michael I. Posner and his colleagues, whose experimental paradigm considerably advanced contemporary understanding of attention, initially proposed this theory
(Posner, 2004). Inspired by the notion of anteriorly and posteriorly
located attentional networks, their model comprises three distinct
attentional control systems: select, orient, and alert. These operations
form three functionally and anatomically unique control systems.
Alerting refers to a change in a person’s internal state in preparation for
perceiving a stimulus. Orienting directs the person’s point of reference
to sensory objects, and the process of selection involves choosing
among conflicting actions. In the field of attention research, focusing
on these components reduces the complex process of attention into
measurable units.
It is now possible to use this model clinically, with the help of noninvasive neuroimaging techniques such as electrophysiological measurements from scalp event-related potentials (ERP), functional magnetic
resonance imaging (fMRI), magnetoencephalography (MEG), near
infrared spectroscopy (NIRS), positron emission tomography (PET),
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241
and single photon emission computed tomography (SPECT). These
tools allow the examination of anatomical and functional changes in
brain activity while a subject performs a task. Their development has
forged an impressive link between psychology and neuroscience over
the past 2 decades (Posner, in press).
Applications of neuroimaging to the field of attention have provided
much information on how the brain houses attentional processes. Initial
efforts to study hypnotic phenomena and attention with neuroimaging
used cerebral blood flow, SPECT, PET, and occasionally fMRI (Baer et al.,
1990; Crawford et al., 1998; Crawford et al., 2000; Halligan, Athwal,
Oakley, & Frackowiak, 2000; Kosslyn, Thompson, Costantini-Ferrando,
Alpert, & Spiegel, 2000; Maquet et al., 1999; Rainville, 2002; Rainville,
Duncan, Price, Carrier, & Bushnell, 1997; Rainville, Hofbauer, Bushnell,
Duncan, & Price, 2000; Rainville, Hofbauer, Bushnell, Duncan, & Price,
2002; Rainville et al., 1999; Szechtman, Woody, Bowers, & Nahmias,
1998). Although not widely used in the field, neuroimaging studies of
hypnotic processes have produced intriguing results. For example,
researchers have used the orienting network as defined by Posner and
colleagues to understand the effects of lesions that produce neglect of
sensory information either by brain damage or by restricting transmitter input. Studies of frontal attention networks have provided similar
understanding of pathologies at higher levels of cognition.
In the clinical arena, research using neuroimaging has even related
attentional networks to attention deficit hyperactivity disorder
(ADHD). Bush et al. used a conflict task to compare adults diagnosed
with ADHD to healthy controls (1999). The healthy subjects showed
more anterior cingulate cortex (ACC) activation than did those diagnosed with ADHD, probably due to higher attentional efficiency.
Although the ADHD group experienced only a slight decrease in performance, their brains activated an entirely different network. Whereas
healthy controls activated the ACC, persons diagnosed with ADHD
relied on the anterior insula—a brain region typically associated with
responses in routine tasks not involving conflict. Recent findings from
a follow-up study indicate that when adults diagnosed with ADHD
are medicated with methylphenidate (e.g., Ritalin), their ACC activation increases toward normal levels (Bush, Spencer, Holmes, Surman, &
Biederman, 2003). Recent neuroimaging data collected from children
diagnosed with ADHD reveals similar trends (Raz, 2004).
ATTENTIONAL NETWORKS
To further investigate attentional networks, we recently devised a
simple Attention Network Test (ANT) that can be performed by
adults, children, and even nonhuman primates (Barnea, Rassis, Raz,
Othmer, & Zaidel, 2004; Fan, McCandliss, Sommer, Raz, & Posner,
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2002; Raz, in press-a; Raz, Fan, et al., in press; Raz, Fossella, et al., in
press; Raz & Shapiro, 2002). The ANT takes about half an hour to
administer and provides three numbers that indicate the efficiency of
the networks that perform the alert, orient, and conflict-resolution
functions. Previously published results prove its reliability, its heritability, and the independence of results for the three different attentional functions (Fan, McCandliss, Flombaum, & Posner, 2001; Fan,
Wu, Fossella, & Posner, 2001; Fossella, Posner, Fan, Swanson, & Pfaff,
2002; Fossella, Sommer, et al., 2002).
Whereas earlier studies examined areas involved in the individual
components of the ANT (Corbetta, Kincade, Ollinger, McAvoy, &
Shulman, 2000; Hopfinger, Buonocore, & Mangun, 2000), recent
reports address the brain areas involved in carrying out the ANT as a
whole (Fan, McCandliss, et al., 2001). These fMRI data suggest that the
test activates three largely orthogonal networks related to components
of attention (see Figure 1). Supporting these findings, Raz and Shapiro
(2002) reported that the pulvinar, superior colliculus, superior parietal
lobe, and frontal eye fields were often active in studies of the orienting
network. The anterior cingulate gyrus is an important part of the
executive network, as it is involved in selective attention and conflict
resolution. The right frontal and parietal areas are active when people
maintain the alert state (Fan, Raz, & Posner, 2003).
Pharmacological studies (e.g., Marrocco & Davidson, 1998) have
related each of the networks with specific chemical neuromodulators.
For example, cholinergic systems arising in the basal forebrain play
an important role in orienting, whereas the norepinephrine system
rooted in the locus coeruleus of the midbrain is involved in alerting.
Lastly, the ACC and lateral prefrontal cortex are target areas of the
mesocortical dopamine system, which is involved in executive
attention.
ATTENTIONAL AND HYPNOTIC PHENOMENA
Hypnosis is often labeled as attentive receptive concentration
(H. Spiegel & Spiegel, 1987). Indeed, evidence relating hypnotic phenomena to attentional mechanisms is mounting (Raz, Shapiro, Fan, &
Posner, 2002b), and there is general agreement that hypnotic phenomena
involve attention (Karlin, 1979) and relate to self-regulation (Posner &
Rothbart, 1998). Although several investigators have hypothesized
that hypnotic suggestibility correlates with underlying differences in
individual patterns of waking attention (Tellegen & Atkinson, 1974),
theories of hypnotic response regarding attentional processes differ
(Kirsch, Burgess, & Braffman, 1999).
The marriage of attention and hypnosis led us to use hypnosis, particularly the Stroop task, to examine disparate attentional networks. In
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Figure 1. Functional anatomy of attentional networks. Cross-sectional views from aggregate fMRI activations acquired from sixteen individuals performing the ANT in a 3 Tesla
magnet (Fan, McCandliss, Flombaum, & Posner, 2001). These activation patterns outline
some of the functional anatomy subserving the three attentional networks. The alerting
effect occurs via thalamic activations, orienting effects occur via parietal activations, and
conflict effects occur via ACC activations.
Figure 2. Spatial locations of significant fMRI activations in Stroop conflict comparing
posthypnotic suggestion with no suggestion in highly hypnotizable individuals. To relate the
fMRI with the ERP data (reported elsewhere), brain electrical source analyses (BESA)
explored the time course of the fMRI generators. Six fixed dipoles were placed at locations
suggested by the fMRI data. The BESA algorithm provided evidence consistent with independent generators at both the anterior cingulate cortex (shown in green) and cuneus
(shown in blue).
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the classic Stroop task, experienced readers are asked to name the ink
color of a displayed word (Stroop, 1935). Responding to the ink color
of an incompatible color word (e.g., the word red displayed in blue
ink), subjects are usually slower and less accurate than when identifying the ink color of a control item (e.g., “***” or lot inked in red). This
difference in performance is called the Stroop Interference Effect (SIE)
and is one of the most robust and well-studied phenomena in attentional
research (MacLeod, 1992; MacLeod & MacDonald, 2000). There has
been a gradual appreciation that attention can mediate word reading.
However, attention remains largely an automatic task, because a proficient reader cannot withhold accessing the word’s meaning despite
explicit instructions to attend only to the ink color. The standard
beliefs in both the word recognition and Stroop fields maintain that
words are automatically processed to the semantic level (MacLeod,
1991; Neely, 1991), thereby making SIE the “gold standard” for studying
attentional measures (MacLeod, 1992; Raz & Shapiro, 2002).
Drawing on behavioral (Raz, Shapiro, Fan, & Posner, 2002a), optical
(Raz, Landzberg, et al., 2003), and neuroimaging assays (Raz, Fan,
Shapiro, & Posner, 2002; Raz et al., 2002a; Raz, Shapiro, Fan, & Posner,
2002c), we recently reported that effective posthypnotic suggestion
consistently cancelled the SIE in highly hypnotizable subjects (Raz
et al., 2002b). This effect was not a result of optical degradation of the
input stimuli (Raz, Landzberg, et al.). Nonetheless, our results indicate
that the effect must operate via a top-down cognitive mechanism that
modifies the processing of input words. Because the SIE typically
activates the dorsal part of the ACC, these data support the view that
monitoring conflict among potential responses also involves the dorsal
ACC (Botvinick, Braver, Barch, Carter, & Cohen, 2001).
Neuroimaging studies of executive attention conducted using
Stroop or Stroop-like tasks have shown activation of midline frontal
areas (e.g., ACC) and the lateral prefrontal cortex (Bush, Luu, &
Posner, 2000). Overall, these tools provide a method of teasing out the
functional contributions of different areas within the executive attention network. Most evidence indicates that lateral prefrontal areas are
involved in representing specific information over time (working
memory), while medial ACC areas are implicated in the detection, resolution, or monitoring of conflict (Kerns et al., 2004).
Using Posthypnotic Suggestion to Reduce Conflict in the Human Brain
Other researchers have attempted to explore the Stroop effect under
hypnosis (Blum & Graef, 1971; Blum & Wiess, 1986; Dixon, Brunet, &
Laurence, 1990a; Dixon & Laurence, 1992; MacLeod & Sheehan, 2003;
Nordby, Hugdahl, Jasiukaitis, & Spiegel, 1999; Sheehan, Donovan, &
MacLeod, 1988; D. Spiegel, Cutcomb, Ren, & Pribram, 1985; Sun, 1994;
Szechtman et al., 1998). However, these assays have largely concen-
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trated on the effect of hypnosis without suggestion and often used
nonclassic Stroop paradigms (Sheehan et al., 1988). Historical singlecase reports (MacLeod & Sheehan, 2003; Schatzman, 1980), obscure
publications (Sun, 1994), and informal personal communications
(Wheatley, personal communication, May 7, 2003) proposing hypnotic
removal of Stroop conflict had not been rigorously studied prior to our
efforts to study conflict removal.
Multiple neuroimaging methods using variations of conventional
Stroop tasks have shown activation of a network of brain areas, including the dorsal ACC. These studies required participants to respond to
one dimension of a stimulus rather than a strong conflicting dimension
(Botvinick et al., 2001; Bush et al., 2000; MacDonald, Cohen, Stenger, &
Carter, 2000). Their results introduced a popular theory of cognitive
control proposing that the ACC is part of a network involved in handling conflict between neural areas (Botvinick, Braver, et al., 2001; Bush
et al., 2000). Whereas some researchers view the ACC through the lens
of a conflict monitoring model (Botvinick et al., 2001; Cohen, Botvinick,
& Carter, 2000; Kerns et al., 2004), others construe it as a regulation
model engulfing broader processes of consciousness and self-regulation,
including executive attention and mentation (Bush et al., 2000).
To unravel the brain mechanism by which the posthypnotic suggestion affects visual processing in the Stroop conflict, we studied highly
hypnotizable and less hypnotizable participants both with and without a suggestion to construe the input words as nonsense strings. We
complemented the high spatial resolution of fMRI by event-related
scalp electrical potentials (ERPs), which afford high temporal resolution. We acquired the fMRI and ERP data separately while the same
participants performed similar Stroop tasks. Elimination of the Stroop
conflict resulted in an attenuation of fMRI signal at the ACC and
extrastriate areas (Raz et al., 2002; Raz et al., 2002a; Raz et al., 2002c).
Posthypnotic suggestion caused highly hypnotizable subjects to view
Stroop words as nonsense foreign signs. This finding illuminated the
mechanism by which the posthypnotic suggestion operated in highly
hypnotizable subjects.
These data are consistent with reports that both attention and suggestion can modulate neural activity for visual stimuli (Kosslyn et al.,
2000; Mack, 2002; Martinez et al., 1999; Rees, Russell, Frith, & Driver,
1999). One such study created a situation in which subjects could look
directly at a five-letter word without attending to it, as they had to
concurrently respond to a superimposed stream of pictures shown in
different orientations. As shown by fMRI, the subjects failed to perceive
words placed at the center of gaze even for decidedly familiar and
meaningful stimuli (Rees et al., 1999). In another study, PET data
showed that highly hypnotizable individuals neither perceive color
nor activate extrastriate areas related to color after receiving instruc-
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tion to see a color pattern in gray-scale (Kosslyn et al., 2000). Finally,
research involving PET assays of pain showed that specific modulatory hypnotic suggestions could affect activation of different brain
structures. Whereas soothing the conflict by suggesting a drop in pain
unpleasantness reduced specific activity in the ACC (Rainville et al.,
1997; Wager et al., 2004), suggesting a decrease in pain intensity
reduced the activity in the somatosensory cortex (Hofbauer, Rainville,
Duncan, & Bushnell, 2001). These accounts underline the influence that
attention and suggestion can impart to conflict situations and top-down
cognitive control (Posner & Rothbart, 1998; Rainville, 2002; Rainville
et al., 2002; Raz & Shapiro, 2002).
Using scalp ERPs offers a higher temporal resolution for investigating
hypnosis. We investigated the effects of suggestion on brain activity
and found an early reduction in brain waves under experimental
suggestion. Electrophysiological activity differed as early as 150 ms
following word presentation. Under suggestion, the N1, an early ERP
component believed to be influenced by attention to a channel of information, was absent. We did not observe posterior activity in the group
that received suggestion until after 250 ms. These findings indicate that
a change in visual input processing caused the absence of conflict. To
relate the fMRI with the ERP data, brain electrical source analyses
(Scherg & Berg, 1990) explored the time course of the fMRI generators
(see Figure 2). These analyses provided evidence consistent with independent generators at both the ACC and cuneus (Raz, in press-b).
In addition to providing the conflict resolution data, this experimental
design demonstrates the possibility of dissociating attention based
either on input processing from sensory activity or on the input
stream. Although this outcome leaves unclear how posthypnotic
suggestion reduced visual input, two potential mechanisms exist.
Either all input decreased, or the reduction was word-specific. Our
ERP data support the former interpretation.
Other relevant ERP data were obtained using the error-related negativity (ERN), an electrophysiological index closely associated with commission of errors in cognitive tasks involving response conflict (Carter
et al., 1998; Falkenstein, Hohnsbein, Hoormann, & Blanke, 1991; Gehring &
Fencsik, 2001). Results showed that although the posthypnotic suggestion reduced conflict, it did not decrease conflict monitoring (Raz, Fan, &
Posner, 2004). In the group that received posthypnotic suggestion, ACC
activation decreased prior to the subjects’ responses. However, ACC
activation increased upon incorrect responses on incongruent trials
regardless of suggestion. Thus, it was possible to eliminate conflict resolution (early ACC diminution) yet maintain conflict monitoring (ACC
activation following incorrect responses).
Finally, recent behavioral data comparing hypnotic and nonhypnotic suggestions using a similar experimental protocol at the Univer-
ATTENTION AND HYPNOSIS
247
sity of Connecticut also showed significant reduction, but not
elimination, of Stroop conflict under both hypnotic and nonhypnotic
suggestions (Pollard, Raz, & Kirsch, 2003). Although susceptibility to
suggestion, not explicit hypnotic procedures, may be the critical factor
underlying Stroop conflict reduction (Braffman & Kirsch, 1999; Kirsch &
Braffman, 2001; Pollard, Raz, & Kirsch, 2003), this model suggests that
individual differences in sensitivity to suggestion and hypnosis may
play an important role in attentional processes.
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GENETICS OF HYPNOTIZABILITY
Most evidence concerning the genetic bases of hypnotizability dates
back 20 to 30 years ago and centers on twin data reported by Morgan
and colleagues (Morgan, 1973; Morgan, Hilgard, & Davert, 1970). The
first study reported a correlation of .63 for monozygotic (MZ) twins
and .08 for dizygotic (DZ) twins, whereas the second study reported
.52 for MZ twins and .18 for DZ twins. Rawlings (1978) and Bauman
and Bul’ (1981) echoed similar findings in subsequent reports. Other
than these general findings, researchers did not pursue the linking of
genetics with hypnotizability until the recent genomics revolution.
Over the past decade, the Human Genome Project has made great
progress in identifying the protean 30,000 genes in the human genome
as well as the approximately 1.7 million polymorphic sites scattered
across the 6 billion base-pair length of the human genome (Wolfsberg,
Wetterstrand, Guyer, Collins, & Baxevanis, 2002). These findings have
illuminated how genes can influence disease development. They have
also aided scientists in the search for genes associated with particular
diseases. In addition, genomics has promoted the discovery of new
treatments and afforded insights into behavioral genetics, such as the
relationship between certain genetic configurations and manifest
behavior.
In the field of hypnotizability, a team led by geneticist Richard
Ebstein has pioneered recent efforts to establish viable correlations relating phenotype and genotype (Bachner-Melman, Ebstein, & Lichtenberg,
2002; Benjamin et al., 2000; Ebstein, Bachner-Melman, & Lichtenberg,
1999; Lichtenberg, Bachner-Melman, Ebstein, & Crawford, 2003;
Lichtenberg, Bachner-Melman, Ebstein, & Crawford, 2004; Lichtenberg,
Bachner-Melman, Gritsenko, & Ebstein, 2000). Using the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) and primarily administering
the test in Hebrew, they have examined a number of such correlations. One
gene they investigated, catechol-O-methioninehyltransferase (COMT),
influences performance on prefrontal executive cognition and
working memory tasks (Weinberger et al., 2001) and is associated with
pain regulation (Wager et al., 2004; Zubieta et al., 2003). Their results
reveal an association between COMT high/low enzyme activity
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polymorphism and hypnotizability (Ebstein et al., 1999; Lichtenberg
et al., 2000). A significant difference in hypnotizability exists between
individuals who carry the valine/methionine and valine/valine
COMT genotypes (Lichtenberg et al., 2003; Lichtenberg et al., 2004;
Lichtenberg et al., 2000).
Given this correlation between COMT and hypnotizability, we set
out to investigate further potential connections. Our previous fMRI
data had identified the ACC as a key node in both the conflict network
and the dopaminergic system (Raz, in press-b; Raz et al., 2002c). Also,
involvement of dopamine in the function of executive attention is well
documented (Marrocco & Davidson, 1998). Furthermore, drugs known
to affect the dopaminergic system while altering consciousness (e.g.,
propofol) induce hypnosis-like experiences (DiFlorio, 1993; Fiset et al.,
1999; Rainville et al., 2002; Xie et al., 2004). Accordingly, we wanted to
reexamine the COMT results reported by Lichtenberg et al. (2000).
Our initial study involved 80 healthy volunteers who provided
DNA samples via sterile cheek swab. We genotyped the DNA samples
for a few well-known genetic polymorphisms involving dopamine,
including DRD3, DRD4, MAOA, DAT, and COMT, as previously
described (Fossella, Posner, et al., 2002; Fossella, Sommer, et al., 2002).
We then compared individual genetic differences with variations in
hypnotic susceptibility, as measured using the SHSS:C without the
anosmia to ammonia item (Raz et al., 2002b). In line with Ebstein’s data
(Ebstein et al., 1999; Lichtenberg et al., 2003; Lichtenberg et al., 2004;
Lichtenberg et al., 2000), we found a polymorphism in the COMT gene
that related to hypnotizability (see Figure 3). Specifically, valine/
methionine heterozygous subjects were more highly suggestible than
either valine/valine or methionine/methionine homozygous subjects.
The inverted U-shaped trend of valine/methionine COMT heterozygotes towards higher hypnotizability is congruent with data reported
by other researchers. However, the data differ from our previous
studies examining the role of COMT in executive attention as measured
by the ANT as well as by the Stroop task (Sommer, Fossella, Fan, &
Posner, in press). The ANT studies found that subjects with the
valine/valine genotype showed somewhat more efficient conflict
resolution (measured by a lower Stroop interference effect) than do
subjects with the valine/methionine genotype (Fossella, Posner,et al.,
2002; Fossella, Sommer, et al., 2002). This trend was also seen in subjects who performed the Stroop task (Sommer, Fossella, Fan, & Posner,
in press). The valine allele of COMT, which confers relatively higher
levels of enzyme activity and thus lower amounts of extrasynaptic
dopamine, has been examined in the context of neuroimaging studies,
where it correlated with lower activity of the dorsolateral prefrontal
cortex (Egan et al., 2001). Results from other genetic polymorphisms,
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Figure 3. COMT and hypnotizability. Distributions of COMT genotypes vs. SSHS:C
hypnotizability score. The Y-axis shows hypnotizability scores (mean ± Standard Error).
The X-axis shows the distribution for each genotypic class at the COMT Valine 108/158
Methionine polymorphism.
including DRD3, DRD4, MAOA and DAT, showed no significant
associations with hypnotizability (Raz, Fossella, et al., 2003).
INDIVIDUAL DIFFERENCES IN ATTENTION AND
HYPNOTIZABILITY
Healthy individuals exhibit differences in the efficiencies of each of
the attentional networks. We can examine this phenomenon by evaluating alerting, orienting, and executive attention using the ANT. Selfreport scales can also reveal individual differences in attentional
components. One higher-level factor called effortful control involves the
ability to voluntarily shift and focus attention and inhibit certain
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information. Effortful control as reported by the subject seems to relate
most closely to the executive attention network. Twin studies have
proposed that individual differences in effortful control are highly
heritable, in agreement with the hypnosis data (Morgan, 1973; Morgan
et al., 1970). Furthermore, individuals high in effortful control also
report themselves as relatively low in negative emotion. These data
suggest that executive attention is important for control of both cognition
and emotion.
Using modified Stroop procedures, researchers have examined
highly hypnotizable versus less hypnotizable subjects outside of hypnosis and report reliable differences in attentional processing
between the two groups (Dixon, Brunet, & Laurence, 1990b; Dixon &
Laurence, 1992). Stroop interference is significantly larger for the
highly hypnotizable individuals compared to the less hypnotizable
persons (Raz et al., 2002a). This finding suggests that outside of the
hypnotic context, highly hypnotizable people process words more
automatically than do their less hypnotizable counterparts. However,
it also implies a significant deviation in baseline efficiency of the
executive attention network in highly hypnotizable people. In this
regard, the nascent COMT findings may herald a genetic approach
(H. Spiegel & Spiegel, 1987) whereby a genotype may suggest a
“biological propensity” to complement an attentional phenotype
such as hypnotizability.
CONCLUSION
This paper has outlined close links between attentional and hypnotic mechanisms while providing preliminary data supporting a candidate gene approach to attention and hypnotizability. Neuroimaging
assays and exploratory genetic associations from the domain of attentional research will continue to illuminate hypnotic phenomena into
the future. Hypnosis is a complex phenomenon that is likely associated
with many genetic polymorphisms. Although COMT is not the “hypnotizability gene,” as data accumulate from multiple laboratories,
meta-analyses across these findings will likely increase our appreciation of genotyping as an important supplement to phenotyping
(Ebstein et al., 1999; Egan et al., 2001; Lichtenberg et al., 2003; Lichtenberg et al., 2000; Lichtenberg et al., 2004; Rawlings, 1978; Raz, 2003a,
2003b; Raz, Fan, et al., in press; Raz, Fossella, et al., in press; Raz, Fossella, et al., 2003; Zubieta et al., 2003). Indeed, genomics is sure to supplement attentional assays and increase our knowledge base (Fan,
Fossella, Sommer, Wu, & Posner, 2003; Fan, Wu, et al., 2001; Fossella,
Posner, et al., 2002; Fossella, Sommer, et al., 2002).
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The possibility of illuminating hypnotic phenomena with attentional paradigms from cognitive neuroscience has become a reality.
Compelling cumulative data demonstrate that hypnosis can significantly alter performance for highly suggestible individuals on attentional tasks such as the Stroop and ANT (Fan et al., 2002; Raz,
2003a, 2003b, in press-a, in press-b; Raz, Fan, et al., in press; Raz et al.,
2004; Raz, Fan, et al., 2002; Raz, Fossella, McGuiness, Zephrani, & Posner, in press; Raz, Fossella, et al., 2003; Raz, Landzberg, et al., 2003; Raz
& Michels, 2004; Raz & Shapiro, 2002; Raz et al., 2002a, 2002b, 2002c).
Results from neuroimaging and genetics studies support a potential
common mechanism of dopaminergic modulation affecting both attentional and hypnotic performance. Such a mechanism may, however,
overlap with different aspects of executive attention. These findings
may reveal a significant disparity between the mechanisms subserving
the cognitive capacities of highly suggestible and less-suggestible individuals (Dixon et al., 1990a, 1990b; Dixon, Labelle, & Laurence, 1996;
Dixon & Laurence, 1992) and are likely to impact future research in the
field.
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ATTENTION AND HYPNOSIS
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Aufmerksamkeit und Hypnose: Neuronale Substrate und genetische
Zusammenhänge von zwei zusammenlaufenden Prozessen
Amir Raz
Zusammenfassung: Obwohl Aufmerksamkeit ein zentrales Thema in der
Psychologie darstellt, beziehen Hypnoseforscher nur selten Befunde aus der
Aufmerksamkeitsforschung in ihre Arbeiten ein. Wie auch andere biologische
Systeme, verfügt auch Aufmerksamkeit über distinkte physiologische
Grundlagen, auf deren Basis psychologische Prozesse ablaufen. Spezifische
Gehirnverletzungen, Bewusstseinszustände und Drogen können allesamt
Aufmerksamkeitsnetzwerke beeinflussen. Die Untersuchung dieser
Netzwerke unter Verwendung moderner bildgebender Verfahren hat
wichtige aufmerksamkeitsbezogene Mechanismen aufgedeckt. Im Zeitalter
der Genforschung könnten genetische Ansätze zusätzlich zu den Befunden
aus bildgebenden Untersuchungen herangezogen werden. Genetische
Untersuchungen stellen ein zunehmend billigeres und praktikableres
Komplement zu phänotypischen Untersuchungen dar. Exploratorische
genetische Untersuchungen ermöglichen Einblicke in die genetischen
Grundlagen von Aufmerksamkeit und Hypnotisierbarkeit. Dieser Artikel
erörtert relevante Aspekte von Aufmerksamkeitsmechanismen und ihrer
zugrundeliegenden Neuroanatomie im Bezug zur Hypnoseforschung.
Befunde aus Studien zu Aufmerksamkeitsnetzwerken, bildgebenden und
genetischen Untersuchungen können dazu beitragen, interindividuelle
Unterschiede der Hypnotisierbarkeit und die mit Hypnose befassten
neuronalen Subsysteme besser zu verstehen.
RALF SCHMAELZLE
University of Konstanz, Konstanz, Germany
Attention et Hypnose : substrats neuronal et association génétiques de deux
processus convergeants
Amir Raz
Résumé : bien que l’attention soit un thème central en science psychologique,
les chercheurs en hypnose intègrent rarement des découvertes sur l’attention
dans leur travail. De même que pour d’autres systèmes biologiques, l’attention
a une anatomie distinctive qui accomplit des fonctions psychologiques de base.
Des états, des drogues, des blessures cérébrales particuliers peuvent influencer
les réseaux de l’attention. Des investigations de ces réseaux, utilisant les
techniques modernes de neuro-imagerie ont révélé d’importants méchanismes
impliqués dans l’attention. Dans cet ère génomique, l’approche génétique peut
complémenter ces techniques de neuro-imagerie. Technologie de plus en plus
viable et peu coûteuse, la recherche de génotype vient en complément du
phénotype : les essais exploratoires génétiques offrent un insight des bases
génétiques à la fois de l’attention et de l’hypnotisabilité. Cet article parle des
différents aspect des méchanismes de l’attention et de leur neuro-anatomie
sous-jacente lorsqu’ils sont liés à l’hypnose. Basée sur des données des réseaux
de l’attention, la neuro-imagerie et la génétique, ces résultats devrait aider à
258
AMIR RAZ
expliquer les différences individuelles d’hypnotasibilité et des systèmes
neuronales favorisant l’hypnose.
VICTOR SIMON
Psychosomatic Medicine & Clinical Hypnosis
Institute, Lille, France
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La atención y la hipnosis: Sustratos neurológicos y asociaciones genéticas de
dos procesos convergentes
Amir Raz
Resumen: Aunque la atención es un tema central en la psicología, los
investigadores de la hipnosis rara vez incorporan los hallazgos sobre la
atención en su trabajo. Al igual que con otros sistemas biológicos, la
atención tiene una anatomía clara que lleva a cabo funciones psicológicas
básicas. Lesiones específicas en el cerebro, estados, y drogas pueden influir
las redes de atención. La investigación de estas redes que utilizan
las técnicas modernas de imágenes cerebrales han revelado mecanismos
importantes implicados en la atención. En esta era de la genética, los
enfoques genéticos pueden suplementar estas técnicas de imágenes.
Conforme la tipología genética llegue a ser un complemento económico y
tecnológicamente viable a la tipología fenotípica, los ensayos genéticos
exploratorios ofrecen una visión sobre las bases genéticas tanto de la
atención como de la hipnotizabilidad. Este trabajo discute aspectos
pertinentes de los mecanismos de atención y su neuroanatomía fundamental
en relación a la hipnosis. Enfatizando la información de las redes de
atención, imágenes cerebrales y la genética, estos resultados ayudan a
explicar las diferencias individuales en la hipnotizabilidad y los sistemas
neurológicos subyacentes a la hipnosis.
ETZEL CARDEÑA
University of Texas, Pan American,
Edinburg, Texas, USA